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Case:Moto
Moto DX 7/5, 13+ (?) year old beautiful intelligent male Abyssinian: New York, NY, USA * PZI Vet (U40), Variable Dosage since summer ‘05 * Went from wildly glucose comatose to self-regulated * Once tested positive for ketones, One experience of neuropathy. * Diabetes onset stimulated by overweight and triggered by steroid injection for urinary inflammation. * No other known health problems * Diet when being regulated: Starkist Light Chunk in water (zero carbs). I prepared fresh organ meats for him which were rejected. I gave him scientifically balanced canned DM which was rejected. I made a concious decision to get his weight up with something that he liked, knowing that it was not "perfect" nutrition. His current diet is highly varied and nutrious. * Previously used Humulin L and Bayer Ascensia Breeze. * Finally used Bayer Ascensia Contour Background: Moto is again a happy, frisky cat. Feral, he adopted us and has been with us now about eight years. We are guessing by his teeth that he is around 14 or so. He may have been previously mistreated as he was suspicious of humans and would claw at attention. Disease Onset: We were traveling for two weeks with a caregiver coming by twice a day to feed Moto, add water, clean his litter, and hang out and play with him. During our trip, as we checked in, everything was fine. Just before our return, we got the message from hell – Moto was running around the house pissing blood. The caregiver took Moto to the vet where we picked him up on our return. Moto had lost several pounds during our absence. He was chubby and overweight before we left but was thin almost painfully thin on our return. We were concerned that the caregiver might not have been coming and feeding him regularly and the Moto had been overstressed, frightened, and angry at the neglect. The vet had tested him and found no infection or sugar in the urine. He injected Moto with Dexamethasone (a steroid) for the urinary irritation. After coming home, he drank constantly and would stand and stare at his water bowl. He was taken back to the vet and diagnosed with diabetes. To ascertain if the diabetes was the effect of some other organ dysfunction, we paid for an extensive (and expensive) battery of tests, including ultrasound. No other problems were detected. First Stage: Denial I couldn’t believe that Moto could contract a serious disease overnight. I thought that with careful diet, the diabetes would relent. I had been feeding Moto fresh fish, Fancy Feast assorted flavors, and Wellness, an expensive designer dry food as a treat and supplement when he got fussy. The dry food had to go immediately. Any dry food is diabetes in a bag. (See http://www.blakkatz.com/dryfood.html about the health dangers of any dry food, even DM). I went to try Purina DM canned, but after a can or two, Moto wouldn’t go near it. An aside about DM: I’ve had problems with Innova and DM, with the store, vet, and distributor stocking and selling out-of-date cans. Even cans that are sold in date could be up to two years old, hard and stale. Any time you buy canned food, check the date stamp and take only current product. Your cat will thank you. Second Stage: Initial Steps With diet not doing the trick, the next least extreme step was trying herbal remedies. I used a pancreas building mix equal parts of Jamul (syzygium cumini), Gymnema Sylvestre, Dog Grass or Couch Grass (elytrigia repens). Unfortunately, Moto rejected food that had even a drop of this mix. I started “logging” although I hadn’t a clue as do what I was supposed to be doing. I bought a Smart Cat Litter Box, developed by a kindly ex-opera singer in Oregon, and moved from waxed corn to safflower seed as litter. The box needs to be rinsed out every week. This box facilitates urine testing and reduces the need to buy, change, and dispose of litter. I started injecting Humilin L and tested urine with Bayer Ketostix. I started with half a unit BID and attempted to keep the Ketostix measurement at 250 while ramping up the dosage by a half unit every two weeks. I was told to keep the injections within a half hour and twelve hours apart. One vet was giving his own cat 4 units BID. Needless to say, this is not a winning approach. Third Stage: Blood Testing One vet suggested that I try blood testing. Unfortunately, neither they nor any other vet I consulted had any direct experience with this. One suggested that I call the Cornell Vet School to get information, but they wanted fifty dollars for a three minute consultation call and no guarantee that they had any information on the subject. Finally, I found some web sites with directions and videos of ear prick techniques. I switched to PZI. Then I had to choose a blood test meter. Tons of models and web sites but no infomation on the best for cats. Blood testers are sold but in general are free along the lines of the razor/razor blade model. My pharmacist gave me a Bayer Ascensia Breeze. Unfortunately, what I didn’t know was the critical feature was sample size. If you don’t have a small sample size, then you have to worry about warming the ear or finding a vein. Eventually, I called Bayer and they sent me a free Ascensia Contour with a much smaller sample size. It doesn't have lots of bells & whistles but it does the job. As technology changes rapidly, get the unit with the smallest drop size. By the way Bayer Customer Service is excellent. They answer the phone quickly and are genuinely helpful. IDEXX customer service is poor. Purina is so-so. At first, I would test once or twice a day as the results are more accurate and timely instead of relying on urine strips. My wife was giving me tremendous push back about hurting the cat. However, once I changed from a meter that needed a large blood drop to one that only needed a drop the size of a pin head (.6ul), everything went much better. Fourth Stage: Tight Regulation The key to success was moving to frequent testing and graphing, rather than logging levels. I cannot emphasize this enough. I''' can’t imagine a cat getting well quickly while receiving uniform doses at regular times. note: Some cats have been regulated or gone into remission while receiving uniform doses at regular times. I am posting my measurements so that anyone so inclined can see what I mean. Moto would respond to insulin in a complicated manner that seemed to depend on the current blood sugar level, the amount insulin he got the last time, the time of day etc. Graphing allows you to guess the BG level inflection points and "predict" the need for insulin. Even with graphing, initially prediction and getting dosage right was a maddeningly frustrating process. What I ended up doing was testing every two to three hours. Frequent testing is a critical necessity. I would inject any time that his blood sugar went above 100. Note: This reading refers to a glucose level of mg/dl, which is the measurement commonly in use in the US. The rest of the world uses the SI measurement of mmol/l. Typical home meter readings for a non-diabetic cat are 50-160 mg/dl. I tried phasing injections to determine his responsiveness. I would inject a unit or less for every hundred over a hundred. But his responsiveness was constantly changing. Hence the need for a graph to visualize and predict how dramatically he would respond to insulin. Once I got the hang of it, he went into remission in only a month. I regret that I wasted so much time, but was unbelievably happy to have him well. His blood sugar level is now typically mid50s to mid60s. I would suggest that aiming to regulate BG at 100 or more will limit your chances of getting your cat completely off insulin and into total remission I used a manual B&D lancet and pricked one mm or less around the perimeter of the tips of the ears. Go in gently at an oblique angle. Try not to go through the ear. If necessary, squeeze or massage a bit to get a tiny drop. Vary ears and locations to avoid scabbing. Moto was very patient with the process and seemed to appreciate that it was for his benefit. Don’t panic if you have hypoglycemia or neuropathy. If you are carefully administering insulin and testing frequently, this shouldn’t happen or were it to, you could nip it in the bud. Don’t administer sugar syrups as in commonly suggested. The sugar shock will damage the pancreas big time, making recovery more difficult. Instead, force feed protein that cat are designed to digest. Using a small syringe, I administered directly down his throat several ounces of Gerbers pure turkey 2nd baby food, if I thought his blood sugar was dropping too low. Then I stayed, watched, and tested until the level rose to normal. But I found that he could go into the teens and not have ill effects. What I learned was his diabetes was like a coma. When it lifted he came to life and regained his energy and enthusiasm. I consulted four vets during this process. Not one of them had experience with home blood testing. Not one flagged the steroid shot as the trigger for this awful episode. Not one thought that I could reverse the diabetes let alone in such a short time. Lessons '''I've Learned: * Have a trusted live-in caregiver when on extended leave * Even nice, well-meaning vets can be of limited to negative value for thoughtful diagnosis and treatment for feline diabetes. sample of vets didn't have the specific knowledge, experience, or interest and so were content to maintain the cat on high insulsin doses rather than strive for remission. I had to educate myself. If you are lucky enough to have a smart proactive vet, perhaps you can effectively collaborate on treatment. * No dry food ever * No steroids ever note: some cats need steroids for particular medical conditions. They can be life-saving and life-enhancing. Steroids are overprescribed to quickly alleviate symptoms, rather than treat or heal illness. * Cats are resilient; remember those nine lives. Hypoglycemia and ketosis risks exist but are IMHO commonly overstated. * Frequent home testing and injection is time effective to reach remission. * Graphing is the only means I know to get real-time dosage correct * You can beat diabetes. If you doubt my isolated experience, go to the website of the brilliant Elizabeth Hodgkins, DVM JD at http://www.yourdiabeticcat.com/protocol.html for detailed protocol information and support. Conclusion Moto is now at a typical blood glucose level of 54. He has boundless energy and affection. My wife tells me that I gave him back his life. Category:Regulated cases Category:Remission cases Category:Male cases Category:Feline cases Category:Humulin L cases Category:PZI Vet cases Category:low-carb cases Category:Neuropathy cases Category:Ketoacidosis cases Category:Tight Regulation cases Category:Feline male cases Category:Feline regulated cases Category:Feline low-carb cases Category:Feline tight regulation cases Category:Feline ketoacidosis cases Category:Feline neuropathy cases Category:PZI cases Category:Steroid-induced cases